Month: April 2018

The United States will face a significant shortage of physicians fueled by population growth, an increase in the number of aging Americans, and retirement of practicing doctors.
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The United States will face a shortage of between 40,800 and 104,900 physicians by 2030, according to a new study commissioned by the AAMC. Released March 14, 2017, the study found that the numbers of new primary care physicians and other medical specialists are not keeping pace with the demands of a growing and aging population.

“There is going to be a significant workforce shortage under all of the likely projections. We see that, quite frankly, only getting worse as the population ages,” said Janis M. Orlowski, MD, AAMC chief health care officer.

The report’s findings are consistent with AAMC estimates from 2015 and 2016. This year’s analysis, conducted by the global information company IHS Markit, extended the date of the projections by five years, from 2025 to 2030, to account for the time needed to fully train a physician who would start medical school in 2017.

For primary care, the estimated shortage will be between 8,700 and 43,100 physicians by 2030. Non-primary care specialties—including medical specialties, surgical specialties, and other specialties—are expected to experience a shortfall of between 33,500 and 61,800 physicians. In particular, the supply of surgeons is projected to have little growth by 2030, but projected demand is expected to increase, resulting in a shortage of between 19,800 and 29,000 surgeons by 2030. For other specialties—emergency medicine, anesthesiology, radiology, neurology, and psychiatry, among others—the projected shortage is between 18,600 and 31,800 physicians by 2030.

The primary factors driving demand are population growth and an increase in the number of older Americans, according to the study. The total U.S. population is expected to grow by about 12% by 2030. Also by 2030, the number of U.S. residents aged 65 and older is expected to increase by 55%, and the number of people aged 75 and older will grow by 73% during the same period.

“This makes the projected shortage especially troubling, since as patients get older they need two to three times as many services, mostly in specialty care, which is where the shortages are particularly severe,” said AAMC CEO and President Darrell G. Kirch, MD.

For all specialties, retirement decisions of practicing doctors will have the greatest effect on future physician supply, the report notes. More than one-third of all active physicians will be 65 or older in the next 10 years.
Factors affecting projections

For the second consecutive year, the 2017 report includes a special analysis of the needs and health care utilization of underserved populations. According to these data, if barriers to utilization were removed and all Americans accessed health care at the same levels as insured, non-Hispanic white patients, the United States would have needed up to 96,800 additional doctors in 2015. About three-quarters of those physicians would have been needed in urban areas.

“There is going to be a significant workforce shortage under all of the likely projections. We see that, quite frankly, only getting worse as the population ages.”

Janis M. Orlowski, MD
AAMC

“With this report, people need to understand that if there were equitable utilization, the workforce needs would be even greater. This is an important issue to remember as we plan for a more equitable future,” Orlowski said.

This year’s study, for the first time, examined how achieving certain population health goals—reducing obesity and diabetes, for example—would affect physician demand. The report concluded that meeting these goals would initially result in a slight decline in physician demand, but an overall increase in demand would occur by 2030 because of increased life expectancy.

“As we work on improving certain chronic diseases, you might think that the need for physicians goes down, but it actually goes up because people live longer,” Orlowski said.

As life expectancy goes up, this scenario would slightly increase demand for some specialists, such as geriatricians. But the need for other specialists—endocrinologists who manage diabetes, for example—likely would go down if fewer people required specialized care for chronic diseases.
Averting the shortage

Multiple approaches will be necessary to address the pending shortage, Orlowski said. The AAMC supports a multipronged solution that includes delivery innovations, team-based care, and better use of technology. But the “biggest solution,” Orlowski said, will be training more physicians.

The AAMC continues to advocate for increased federal support for an additional 3,000 residency positions annually over the next five years. Although medical schools have expanded class sizes, it will be hard to increase the overall number of practicing physicians without greater support for graduate medical education.

“We urge Congress to approve a modest increase in federal support for new doctors,” Kirch said. “Expanded federal support, along with all medical schools and teaching hospitals working to enhance education and improve care delivery, would be a measured approach to solve what could be a dangerous health care crisis.”

The PhA-eAML Physician Associate Project mission is to bring back US citizen foreign-trained MDs to serve California and eventually nationwide. US foreign trained Medical doctors can practice independently with a new license called PhA Physician Associate. The new license is the solution once and forever to indefinitely close the drama of foreign-trained MDs mistreatment since the ECFMG established in 1956!

The USMLEs are the American standardized quality for practicing medicine. Its importance and influence on international medicine practice is beneficial for both America as one of the most powerful nations of the world and the international nations to match themselves to a realistic system for their levels of quality of healthcare services. The pursuing of USMLEs by foreign-trained MDs from all over the world is one of the diversity beacons that would continue to bring about the refreshing American Dreams and keep remaking America and the world history closer to perfection. We, foreign-trained MDs who have been proud to be US citizens bring on our citizenship responsibility to maintain and to flourish the great stories of remaking America and the world in this spectrum of the profession of humanity.

The reason for this PhA project is because these foreign-trained MDs, who had attended and graduated from medical schools approved American-Accredited Medical Education Standards from foreign countries from all over the world, though already pass all the USMLEs (step 1, step 2 CK, step 2 CS and obtained the ECFMG certificate) are unable to finalize their MD licenses because they are rejected to work in medical residency programs in which their MD licenses would be granted (the biggest excuse is these doctors have graduated more than three years out of medical schools). This renders thousands and thousands of wasteful MDs talents for the American public while America has been facing serious shortage of physicians in present, near, and far future! It is a stark reality! The whole picture is rather a contradiction of the absurdities of the current licensing system that has become detached from sincerely serving our communities.

To be able to practice medicine in the US, any professional should have a powerful piece of paper called the license.

The current medical residency has been mistreating US citizen foreign-trained MDs in many ways: they practice age discrimination, they sponsor visa for freshly graduated international MDs who are not related to the US to outsource resident jobs that should be placed for US citizen foreign trained MDs besides domestic trained MDs.

This phenomenon has been in the past, present and surely still continuing into the future unless we take some resolute actions. Although there have been many movements trying to solve the problem by expanding more residency slots, opening new medical schools, etc. these kinds of approach only gives more power to residency programs and opening more medical schools only aggravate the burden of the already-sickening system and to continue mistreating US-FMDs.

This phenomenon should be explained as “The Swiss Cheese Effect” in wrong management when one fault from the previous section leads to mistakes in the next and next steps in a process of management. This does not mean to name and/or to accuse any individual. However, it needs to be addressed exactly the problem.

Understanding this painful and intricate problem, we have found the PhA American Physician Associates to carry on the mission as a new license called Physician Associates so that there is an independent pathway for foreign-trained MDs who can work for a few years e.g. three to four years before they eventually finalize their MD licenses.

To be able to realize this ultimate goal, first of all, a pilot program should be sanctioned by the California Governor Office. The governor should approve for The PhA organization or a sponsor entity e.g. the Office of Statewide Health Planning and Development OSHPD (https://www.oshpd.ca.gov/ to be able to carry on the pilot program of PhA Physician Associate residency and placement into jobs in California so that this pilot program would eventually spread out statewide when it works out right.

The description of the pilot program: a six months with possible 3 months extensions of residency for PhA Physician Associates. The residency program is designed according to the standard of any existent primary care residency program in California for MDs with modifications for PhA level of scopes of practice. The levels and scopes of practice of PhA would be higher than PAs as Physician Assistants and NPs Nurse Practitioners, but lower than licensed MD and PhAs are supposed to collaborate with licensed MDs at the ratio of one licensed MD for every ten to fifteen PhAs.

We need the governor to approve for the PhA organization to establish this pilot program to prove that US person foreign-trained MDs with ECFMG certificates can do a good job just like any other licensed MDs to serve the community. From here, the new license PhA will come into sight in the new law.

Once the establishment of the program developed and well organized, there would be open doors for other types of foreign-trained MDs besides US person foreign-trained MDs.

We sincerely ask all and everybody, no matter what, where and who you are, MDs or any professionals or the public, US persons or internationally located, to support this project because of both its short-term and long-term benefits would be tremendous to serve many small and big issues of our current broken healthcare system for the US as nationwide and even internationally when it develops full-fledged.